Provider Demographics
NPI:1972297034
Name:PORTILLO, ERICA (LMFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22742 CYPRESSWOOD DR # 1127
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7121
Mailing Address - Country:US
Mailing Address - Phone:832-299-4720
Mailing Address - Fax:
Practice Address - Street 1:22742 CYPRESSWOOD DR # 1127
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7121
Practice Address - Country:US
Practice Address - Phone:832-299-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist